Provider Demographics
NPI:1558722827
Name:SALAS, JASMIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:SALAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3509
Mailing Address - Country:US
Mailing Address - Phone:325-480-9280
Mailing Address - Fax:325-400-2007
Practice Address - Street 1:1124 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3862
Practice Address - Country:US
Practice Address - Phone:980-487-1148
Practice Address - Fax:704-487-7753
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC0010-06347363A00000X
TXPA12250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558722827Medicaid
SC2609PAMedicaid
NCNCS416AMedicare PIN
SC2609PAMedicaid